title: Surgical treatment of non-small cell lung cancer in octogenarians - safety and prognosis.
abstract: BACKGROUND
  Reluctance to recommend surgery for the elderly is partly based on the expectation that the rate of complications and mortality is higher in this group of patients and on the impression that the life expectancy of an octogenarian with lung cancer is limited by death from natural causes.
  
  
  METHODS
  Between 2007-2011, we operated on 57 patients over 80 years who underwent thoracotomy with curative intent for lung cancer. Mean age was 82.2 years, 17 were female and 40 male. The presence of preoperative comorbidities in this group of patients was significant: chronic lung disease - 22.8%, cardiovascular disease - 38.6% and a history of other malignancy - 17.5%. However, their respiratory function was very acceptable with an average FVC of 93.6% and an average FEV1 of 83.2%. The predominant location of tumor (mean size of 3.0±1.7 cm) was upper lobes (63.2%) and cytological diagnosis was established preoperatively in 61.4% of cases. Preoperative staging was complemented by positron emission tomography in 42.1% of cases and in 12.2% with mediastinoscopy.
  
  
  RESULTS
  We performed 35 lobectomies (61.4%), 4 bilobectomies (7.0%), 9 wedge resections (15.8%) and 5 pneumonectomies (8.8%). All surgeries were performed through lateral thoracotomy. In 4 patients (7.0%), anatomic resection was aborted intraoperative due to unexpected metastatic disease and/or unresectable mass discovered during exploratory thoracotomy. Lymph node dissection was complete in 57.8%. Final pathology analysis showed: adenocarcinoma in 50.9% of cases, squamous cell carcinoma in 14.0% and carcinoid tumour in 14.0%. Final staging was T1 (24.4%), T2 (26.7%), T3-4 (11.1%), N0 (35.5%), N1-2 (4.4%), G1 (8.9%), G2 (28.9%), G3 (8.9%). Mean hospital stay was 10.7±8.1 days. Main surgical complications recorded were: prolonged air leak (15.8%), atelectasis requiring bronchoscopy (7.0%) and persistent air chamber on chest roentgenography (10.5%). We observed an overall operative mortality of one case - 1.8%, which was an 80 year-old patient submitted to a pneumonectomy.
  
  
  CONCLUSIONS
  In conclusion, octogenarians should not be denied surgery exclusively due to age. Surgeons should base their decision first on the stage of the disease, and then on an accurate assessment of the general clinical conditions. Pneumonectomy and extended operations should generally be avoided.
authors.affiliation: Departamento de Cirurgia Cardiotorácica do Centro Hospitalar de Vila Nova de Gaia/Espinho - Portugal.
authors.forename: Paulo C
authors.initials: PC
authors.lastname: Neves
authors.forename: Miguel
authors.initials: M
authors.lastname: Guerra
authors.forename: Daniel
authors.initials: D
authors.lastname: Martins
authors.forename: Paulo
authors.initials: P
authors.lastname: Ponce
authors.forename: José
authors.initials: J
authors.lastname: Miranda
authors.forename: Luís
authors.initials: L
authors.lastname: Vouga
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D049268:Positron-Emission Tomography; D011379:Prognosis; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome